Rejected Claims from Failed Eligibility Checks
Definition
Failure to perform Online Patient Verification (OPV) or Online Eligibility Checking (OEC) results in incorrect patient details, causing claim rejections and lost revenue from unbilled services.
Key Findings
- Financial Impact: AUD 500-2,000 per rejected claim; 5-10% revenue leakage from verification failures
- Frequency: Per patient admission or service
- Root Cause: Manual data entry errors and failure to recheck eligibility changes
Why This Matters
Services for Elderly and Disabled providers in Australia waste AUD 10,000+ annually on rejected claims. Automation of OPV/OEC eliminates verification errors.
Affected Stakeholders
Billing staff, Practice managers, Healthcare providers
Deep Analysis (Premium)
Financial Impact
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Current Workarounds
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Methodology & Sources
Data collected via OSINT from regulatory filings, industry audits, and verified case studies.
Related Business Risks
Out-of-Pocket Surprise Churn
Delayed Claims from Eligibility Verification Delays
NDIS Incident Reporting Penalties
Governing Body Determination Application Fees and Delays
Assessment Waiting List Delays
Non-Compliance History in Reassessments
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